Healthcare Provider Details

I. General information

NPI: 1962618728
Provider Name (Legal Business Name): ERICA ANNE SWANGER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S BLAINE ST STE 21
MOSCOW ID
83843-3973
US

IV. Provider business mailing address

1420 S BLAINE ST STE 21
MOSCOW ID
83843-3973
US

V. Phone/Fax

Practice location:
  • Phone: 360-961-3751
  • Fax:
Mailing address:
  • Phone: 360-961-3751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00017620
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAS2488
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberRF60485502
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: